PC3 Module 3 (no medchem)

Which of the following is NOT a component of lipoproteins?

a.) Cholesterol

b.) Triglycerides

c.) Carbohydrates

d.) Phospholipids

e.) Proteins

c.) Carbohydrates

Which of the following has the most lipids, but the least protein?

a.) Chylomicrons

b.) LDL

c.) HDL

a.) Chylomicrons

Between LDL and HDL, which has more protein, but less lipids?

a.) LDL

b.) HDL

b.) HDL

--"Good Cholesterol"

Between LDL and HDL, which has less protein, but more lipids?

a.) LDL

b.) HDL

a.) LDL

--"Bad Cholesterol"

Which of the following emulsifies cholesterol into micelles?

a.) Bile acids

b.) Fatty acids

a.) Bile acids

Which of the following synthesizes triglycerides and incorporates them into chylomicrons?

a.) Bile acids

b.) Fatty acids

b.) Fatty acids

TRUE or FALSE: VLDL is made up of cholesterol and triglycerides, and is transported into the blood via the liver

TRUE

Which of the following is a correct statement?

a.) IDL is converted to VLDL, which is then metabolized into LDL

b.) VLDL is converted to IDL, which can be either cleared by hepatic IDL receptors, or metabolized into LDL

b.) VLDL is converted to IDL, which can be either cleared by hepatic IDL receptors, or metabolized into LDL

Which type of dyslipidemia is caused by diet, drugs, and diseases?

a.) Primary (familial)

b.) Secondary (acquired)

b.) Secondary (acquired)

Which type of familial hypercholesterolemia is acquired at younger ages (younger than 20)?

a.) Heterozygous

b.) Homozygous

b.) Homozygous

Which type of familial hypercholesterolemia is passed down from one parent only?

a.) Heterozygous

b.) Homozygous

a.) Heterozygous

Which type of familial hypercholesterolemia is passed down from both parents?

a.) Heterozygous

b.) Homozygous

b.) Homozygous

Which of the following is a marker for inflammation and may be useful in identifying high-risk cardiovascular patients, according to the response-to-injury hypothesis?

a.) F-reactive protein

b.) G-reactive protein

c.) S-reactive protein

d.) C-reactive protein

d.) C-reactive protein

Which of the following is the term for atherosclerotic plaque formation, when LDL migrates into vessel walls and is oxidized and taken up by macrophages, which reduce ability of endothelium dilation and produce proteinases that make plaques unstable?

a.) Hyperdyslipidemia

b.) Atherogenesis

c.) Atherosclerosis

d.) Hypercholesterolemia

b.) Atherogenesis

Which of the following classes of antihyperlipidemic agents is known as the "king" of all of them?

a.) PCSK9 Inhibitors

b.) Fibric Acid Derivatives

c.) HMG-CoA Reductase Inhibitors

d.) Nicotinic Acid

c.) HMG-CoA Reductase Inhibitors

--aka "Statins"

Which of the following classes of antihyperlipidemic agents are known as "the hand of the king"?

a.) HMG-CoA Reductase Inhibitors

b.) Cholesterol Absorption Inhibitors, PCSK9 Inhibitors, ATP-Citrate Lyase Inhibitors, Omega-3 Fatty Acids

c.) Fibric Acid Derivatives, Nicotinic Acid, Bile Acid Sequestrants, Microsomal Triglyceride Transfer Protein Inhibitors, Angiopoietin-Like Protein 3 Inhibitor

b.) Cholesterol Absorption Inhibitors, PCSK9 Inhibitors, ATP-Citrate Lyase Inhibitors, Omega-3 Fatty Acids

TRUE or FALSE: HMG-CoA Reductase Inhibitors (Statins) are first-line therapy for managing dyslipidemia

TRUE

TRUE or FALSE: Statins decrease intracellular cholesterol synthesis via inhibition of HMG-CoA Reductase, as well as increase LDL-receptor synthesis to remove LDL from the bloodstream to be downgraded intracellularly

TRUE

TRUE or FALSE: Statins have minimal first-pass metabolism

FALSE

--Extensive first-pass metabolism

Which of the following statins is NOT metabolized by CYP3A4?

a.) Pravastatin

b.) Atorvastatin

c.) Lovastatin

d.) Simvastatin

a.) Pravastatin

--Remember the 3 in CYP3A4, so 3 statins metabolized by CYP3A4

--Remember you learned it in ALS (Atorvastatin, Lovastatin, Simvastatin)

Which of the following transporters interacts with all of the statins?

a.) P-gp (efflux)

b.) OATP1B1 and OATP1B3 (influx)

b.) OATP1B1 and OATP1B3 (influx)

--P-gp only interacts with Atorvastatin, Lovastatin, Simvastatin, and Pravastatin

Which statin is not metabolized to any extent by CYP enzymes, and is excreted unchanged in the urine?

a.) Rosuvastatin

b.) Pravastatin

c.) Fluvastatin

d.) Pitavastatin

b.) Pravastatin

TRUE or FALSE: Statins can also increase HDL and decrease triglycerides

TRUE

What determines the therapeutic effect of statins?

a.) Bioavailability

b.) Volume of Distribution

c.) Prodrug vs Non Prodrug

d.) Intensity

d.) Intensity

Which of the following is NOT considered a high-intensity statin regimen?

a.) Simvastatin 20-40 mg

b.) Rosuvastatin 20-40 mg

c.) Atorvastatin 40-80 mg

a.) Simvastatin 20-40 mg

Which statin is NOT recommended by the FDA to be initiated at 80 mg/day due to increased risk of myopathy when given at that dose?

a.) Atorvastatin

b.) Pravastatin

c.) Simvastatin

d.) Lovastatin

c.) Simvastatin

Can you initiate statin therapy in chronic liver disease, compensated cirrhosis, or NAFLD?

a.) Yes

b.) No

a.) Yes

Can you initiate statin therapy in acute liver failure or decompensated cirrhosis?

a.) Yes

b.) No

b.) No

What should be obtained prior to starting statin therapy, to prevent hepatotoxicity?

a.) Serum creatinine levels

b.) Blood urea nitrogen levels

c.) Potassium levels

d.) Serum transaminase levels

d.) Serum transaminase levels

--Also creatinine phosphokinase should be monitored

TRUE or FALSE: Statin-Associated Muscle Symptoms (SAMS), such as myopathy, myalgia, and rhabdomyolysis, have a higher risk of happening at higher doses of statins

TRUE

What if you have intolerable symptoms of SAMS from statin therapy?

a.) Continue therapy

b.) Discontinue therapy

b.) Discontinue therapy

What if your SAMS symptoms resolve after discontinuing statins?

a.) Stay off the statin completely

b.) Try again

b.) Try again

TRUE or FALSE: Gemfibrozil can be combined with statins for better therapy

FALSE

--Avoid combining Gemfibrozil and statins

Which dose of Niacin can be combined with statins?

a.) 0.5 grams

b.) 1.5 grams

c.) 2.5 grams

d.) No dose is safe to combine with statins

a.) 0.5 grams

--Anything more than 1 gram of Niacin is contraindicated with statins

What is the max dose of Simvastatin with Amlodipine or Amiodarone?

a.) 10 mg

b.) 20 mg

c.) 40 mg

d.) 80 mg

b.) 20 mg

What is the max dose of Simvastatin with Diltiazem or Verapamil?

a.) 10 mg

b.) 20 mg

c.) 40 mg

d.) 80 mg

a.) 10 mg

Recheck lipid panel 4-12 weeks after starting or adjusting statin therapy. If 2 consecutive LDL levels less than (BLANK), consider dose decrease

a.) 20 mg/dL

b.) 40 mg/dL

c.) 60 mg/dL

d.) 80 mg/dL

b.) 40 mg/dL

Which of the following is the statin of choice in renal impaired patients?

a.) Simvastatin

b.) Pravastatin

c.) Atorvastatin

d.) Lovastatin

c.) Atorvastatin

TRUE or FALSE: Statins are contraindicated in pregnancy and discouraged during lactation

TRUE

What drug class is Ezetimibe?

a.) HMG-CoA Reductase Inhibitor

b.) Bile Acid Sequestrant

c.) Cholesterol Absorption Inhibitor

d.) Nicotinic Acid

c.) Cholesterol Absorption Inhibitor

TRUE or FALSE: There is a modest reduction in risk of recurrent cardiovascular events when Ezetimibe is used with a statin

TRUE

Which of the following is the mechanism of action for Ezetimibe?

a.) Inhibits NPC1L1 protein

b.) Reduces cholesterol in chylomicrons

c.) Increases expression of LDL receptors and cholesterol biosynthesis, leading to higher LDL clearance

d.) All of the above

d.) All of the above

What is the main metabolism of Ezetimibe?

a.) CYP enzyme degradation

b.) Glucuronidation

c.) Sulfation

d.) Demethylation

b.) Glucuronidation

TRUE or FALSE: Ezetimibe can be used as monotherapy for statin intolerance

TRUE

(BLANK) may increase exposure to both Ezetimibe and itself

a.) Cyclosporine

b.) Bile acid sequestrants (ex. Cholestyramine)

a.) Cyclosporine

(BLANK) decreases absorption of Ezetimibe, and may need a separate administration time if patient is on both

a.) Cyclosporine

b.) Bile acid sequestrants (ex. Cholestyramine)

b.) Bile acid sequestrants (ex. Cholestyramine)

Is renal adjustment needed with Ezetimibe?

a.) Yes

b.) No

b.) No

TRUE or FALSE: Ezetimibe is contraindicated in both pregnancy and lactation

TRUE

Which drug class do both Alirocumab (Praluent) and Evolocumab (Repatha) belong to?

a.) Cholesterol Absorption Inhibitors

b.) Bile Acid Sequestrants

c.) HMG-CoA Reductase Inhibitors

d.) PCSK9 Inhibitors

d.) PCSK9 Inhibitors

TRUE or FALSE: PCSK9 Inhibitors, such as Praluent and Repatha, reduce the degradation of LDL receptors by blocking PCSK9, leading to increased hepatic clearance of LDL from circulation

TRUE

TRUE or FALSE: PCSK9 Inhibitors, such as Praluent and Repatha, are safe in pregnancy and lactation

FALSE

Which of the following drugs blocks the synthesis of PCSK9 and is injected 284 mg sq every 3-6 months?

a.) Inclisiran (Leqvio)

b.) Alirocumab (Praluent)

c.) Evolocumab (Repatha)

d.) Ezetimibe

a.) Inclisiran (Leqvio)

How often are Praluent and Repatha injected?

a.) Every day

b.) Every week

c.) Every 2-4 weeks

d.) Every 4-6 weeks

c.) Every 2-4 weeks

Which dose of Evolocumab (Repatha) can be used for HoFH?

a.) 140 mg every 2 weeks

b.) 420 mg every 4 weeks

b.) 420 mg every 4 weeks

Which dose of Alirocumab (Praluent) can be used for HoFH?

a.) 75 mg every 2 weeks

b.) 300 mg every 4 weeks

c.) 150 mg every 2 weeks

c.) 150 mg every 2 weeks

Which drug class is Bempedoic Acid (Nexletol)?

a.) ATP-Citrate Lyase Inhibitor

b.) Fibric Acid Derivative

c.) Nicotinic Acid

d.) Angiopoietin-Like Protein 3 Inhibitor

a.) ATP-Citrate Lyase Inhibitor

TRUE or FALSE: Bempedoic Acid is a prodrug

TRUE

TRUE or FALSE: Bempedoic Acid blocks ACL's conversion of citrate to acetyl CoA, which reduces flow of acetyl CoA to HMG-CoA reductase

TRUE

Cholesterol-lowering effects of Bempedoic Acid are additive with (BLANK)

a.) Nicotinic Acids

b.) HMG-CoA Reductase Inhibitors

c.) Cholesterol Absorption Inhibitors

d.) Bile Acid Sequestrants

b.) HMG-CoA Reductase Inhibitors

Which of the following options gives the best therapeutic effects with Bempedoic Acid (Nexletol)?

a.) Monotherapy

b.) Plus Ezetimibe

c.) Triple therapy

c.) Triple therapy

Which drug causes hyperuricemia?

a.) Atorvastatin

b.) Ezetimibe

c.) Repatha

d.) Bempedoic Acid

d.) Bempedoic Acid

--Niacin also causes this

Omega-3 Fatty Acids are FDA-approved for triglyceride levels of (BLANK)

a.) Greater than or equal to 250 mg/dL

b.) Greater than or equal to 300 mg/dL

c.) Greater than or equal to 450 mg/dL

d.) Greater than or equal to 500 mg/dL

d.) Greater than or equal to 500 mg/dL

TRUE or FALSE: The mechanism of action of Omega 3 Fatty Acids is not completely understood

TRUE

Omega-3 Fatty Acids (BLANK) hepatic oxidation of free fatty acids, LDL hydrolysis through PPARa activation, and triglyceride clearance from VLDL particles

a.) Decrease

b.) Increase

b.) Increase

Omega-3 Fatty Acids (BLANK) hepatic triglyceride synthesis and incorporation of triglycerides into VLDL

a.) Decrease

b.) Increase

a.) Decrease

Which of the following Omega-3 Fatty Acid medications is the only one to reduce ASCVD risk?

a.) Lovaza--ethyl ester of EPA/DHA

b.) Epanova--carboxylic acid of EPA/DHA

c.) Vascepa--ethyl ester of EPA only

c.) Vascepa--ethyl ester of EPA only

What is the optimal dose of Vascepa?

a.) 1 gram twice daily (2 grams/day)

b.) 2 grams twice daily (4 grams/day)

c.) 1 gram three times daily (3 grams/day)

d.) 2 grams three times daily (6 grams/day)

b.) 2 grams twice daily (4 grams/day)

What is the most common side effect of Omega-3 Fatty Acids?

a.) Urinary effects (decreased urination, painful/burning urination)

b.) Hepatotoxicity

c.) GI effects (abdominal pain, nausea, fish burps)

d.) Drowsiness

c.) GI effects (abdominal pain, nausea, fish burps)

TRUE or FALSE: Omega-3 Fatty Acids can decrease bleeding time, making them great to take with anticoagulants

FALSE

--Prolong bleeding time, do not take with anticoagulants, antiplatelets, or anti-inflammatories

Where should you store Omega-3 Fatty Acids to reduce GI complaints?

a.) Fridge

b.) Freezer

a.) Fridge

--NEVER freeze these drugs

TRUE or FALSE: Omega-3 Fatty Acids are the most common supplement purchased

TRUE

Which drug class are both Fenofibrate (Tricor) and Gemfibrozil (Lopid) a part of?

a.) Nicotinic Acid

b.) Bile Acid Sequestrants

c.) Fibric Acid Derivatives

d.) ATP-Citrate Lyase Inhibitors

c.) Fibric Acid Derivatives

Which type of Fibric Acid Derivative therapy reduces cardiovascular events?

a.) Monotherapy

b.) Combined therapy with statin

c.) Combined therapy with Ezetimibe

d.) Triple therapy with both statin and Ezetimibe

a.) Monotherapy

Which drug class is the drug of choice for Hyperlipoproteinemia, Severe Hypertriglyceridemia (higher than 1000 mg/dL), and Chylomicronemia syndrome?

a.) HMG-CoA Reductase Inhibitors

b.) Bile Acid Sequestrants

c.) Omega-3 Fatty Acids

d.) Fibric Acid Derivatives

d.) Fibric Acid Derivatives

TRUE or FALSE: Fibric Acid Derivatives are mainly used in Hypertriglyceridemia and reduce the risk of pancreatitis

TRUE

What receptor does Fibric Acid Derivatives interact with?

a.) AT1R

b.) PPARa

c.) GABA

d.) D2

b.) PPARa

TRUE or FALSE: Fibric Acid Derivatives may increase LDL

TRUE

Which Fibric Acid Derivative is better at increasing HDL?

a.) Fenofibrate

b.) Gemfibrozil

a.) Fenofibrate

Which Fibric Acid Derivative CANNOT be used with statins?

a.) Fenofibrate

b.) Gemfibrozil

b.) Gemfibrozil

Can Fibric Acid Derivatives be used in pregnancy?

a.) Yes

b.) No

b.) No

Which drug class is Niacin in?

a.) Bile Acid Sequestrant

b.) Cholesterol Absorption Inhibitor

c.) Omega-3 Fatty Acid

d.) Nicotinic Acid

d.) Nicotinic Acid

TRUE or FALSE: Niacin has cardiovascular benefit

FALSE

TRUE or FALSE: Niacin inhibits lipolysis in adipose tissue, decreases hepatic synthesis of triglycerides, reduces hepatic synthesis of VLDL and LDL, and reduces HDL catabolism

TRUE

TRUE or FALSE: Niacin is the most effective agent in increasing HDL

TRUE

Which form of Niacin has less side effects?

a.) IR

b.) ER

b.) ER

TRUE or FALSE: You can use Niacin in pregnancy

FALSE

TRUE or FALSE: Combining Niacin and statins decreases a patient's ASCVD risk

FALSE

TRUE or FALSE: Niacin can be used as monotherapy if patient is statin intolerant

TRUE

What drug class is Cholestyramine (Prevalite), Colestipol (Colestid), and Colesevelam (Welchol) in?

a.) HMG-CoA Reductase Inhibitors

b.) Bile Acid Sequestrants

c.) Nicotinic Acids

d.) Fibric Acid Derivatives

b.) Bile Acid Sequestrants

TRUE or FALSE: Bile Acid Sequestrants stimulate hepatic synthesis of bile acids from cholesterol and bind to them, inhibiting enterohepatic circulation of bile acids and preventing their reabsorption

TRUE

--Also increase LDL receptors and cholesterol biosynthesis LDL uptake and catabolism

Which drug class is reserved for those intolerant to Ezetimibe?

a.) Bile Acid Sequestrants

b.) Nicotinic Acids

c.) Omega-3 Fatty Acids

d.) Fibric Acid Derivatives

a.) Bile Acid Sequestrants

TRUE or FALSE: Bile Acid Sequestrants can be used as adjunct therapy with statins

TRUE

TRUE or FALSE: Bile Acid Sequestrants are well tolerated

FALSE

--Poorly tolerated due to GI issues

Which form of Bile Acid Sequestrants is better tolerated (less GI effects)?

a.) Powder

b.) Tablet

b.) Tablet

Can you use Bile Acid Sequestrants in pregnancy?

a.) Yes

b.) No

a.) Yes

Bile Acid Sequestrants are contraindicated in what condition?

a.) Dyslipidemia

b.) Hypertriglyceridemia

c.) Atherosclerosis

d.) Myocardial Infarction

b.) Hypertriglyceridemia

What drug class is Lomitapide mesylate (Juxtapid) in?

a.) Bile Acid Sequestrants

b.) Nicotinic Acid

c.) Microsomal Triglyceride Transfer Protein Inhibitor

d.) Angiopoietin-Like Protein 3 Inhibitor

c.) Microsomal Triglyceride Transfer Protein Inhibitor

What is Juxtapid approved for?

a.) HeFH

b.) HoFH

b.) HoFH

TRUE or FALSE: Juxtapid binds to and inhibits MTP, preventing assembly of apo-B lipoproteins in enterocytes and hepatocytes, reducing formation of VLDLs and chylomicrons, and reducing LDL levels

TRUE

Can you combine Juxtapid and a statin?

a.) Yes

b.) No

a.) Yes